Medical imaging

Acoustic Times or . . . Scan you believe it! - A quality publication. Ultrasound governance: communicating standards during a pandemic (2023)

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Type of publication:Conference abstract

Author(s):*Brown H.

Citation:Ultrasound. Conference: 53rd Annual Scientific Meeting of the British Medical Ultrasound Society. Cardiff United Kingdom. 31(2) (pp NP32), 2023. Date of Publication: May 2023.

Abstract:Introducing new governance processes into a multisite ultrasound department during a pandemic led to the re-thinking of the models of communication used to share governance objectives. The introduction of peer review audit can be challenging for staff. Clear communication is vital to ensure staff are not threatened by the process and are able to use it as a learning opportunity to shape their practice and development, thereby improving patient safety. A monthly newsletter Acoustic Times was introduced to explain the processes and changes giving the opportunity to provide the evidence base and links to national guidance. Peer review audit and learning meetings were introduced and held virtually across sites to identify and share any individual or group learning points. Processes and documents were either redesigned or introduced, with supporting rationale and evidence provided through the newsletter including: evidence based protocols; standard setting; peer review audit, including supporting learning outcomes and CPD; actionable reporting; preceptorship; service user feedback; and equipment QA. Further supported learning was provided on critical reflection, specific focus on technical aspects of clinical examinations, sharing of external learning events, CPD and inhouse ultrasound training. Benefits of the newsletter include: more focus on improving consistency of practice and setting standards; faster reporting of audit findings and reaudits; and improved engagement with consultant colleagues. It also provides an accessible record of the development of governance processes which has been shared with sonographers in other organisations. Setting and communicating clearly defined quality standards and protocols is key to the design of safe working practices and patient safety in healthcare environments.1 Open and honest governance processes with clear, accessible and useable documentation are key in staff engagement and ownership of quality improvement.

All sleep and no play? An audit and service evaluation of children undergoing radiological imaging (2022)

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Type of publication:
Conference abstract

Author(s):
*Muneer K.

Citation:
Archives of Disease in Childhood. Conference: Royal College of Paediatrics and Child Health Conference, RCPCH 2022. Liverpool United Kingdom. 107(Supplement 2) (pp A120-A121), 2022. Date of Publication: August 2022.

Abstract:
Aims The use of sedation in children for radiological imaging is common practice in Paediatrics. However, the risks need to be weighed against the benefits of imaging under sedation. Play therapy has been considered as an alternative to sedation in a cooperative child. This study explored the safety, efficacy and adherence of practice to local trust guidelines for sedation of children (derived from the NICE Sedation under 19s guidelines) and highlighted play therapy as a potential alternative for selected children requiring radiological imaging. Methods Data was gathered retrospectively from a 6 month period with the help of the Trust's medical records department. There were 36 children who underwent sedation for various imaging modalities and 19 children who had imaging done utilising play therapy over the same period. The information gathered from the resources used was collated in an excel database for the purpose of comparative analysis. Results 1. The assignment of patients was based on their clinical presentation, urgency and medical background 2. Children receiving sedation were predominantly below the age of 3 years while those in the play group were between 6-9 years 3. The youngest child to receive sedation was 3 months old and the youngest to have successful MRI using play therapy was 3 years 5 months 4. The success rate of Sedation was 92% vs. 86% for play therapy 5. 83% underwent MRI, 11% DMSA and 6% MAG3 under sedation. 95% had MRI and 5% CT in the play group 6. 14% required a repeat dose of medication for sedation 7. None had complications secondary to sedation 8. One had MRI Head done under sedation and later MRI Spine successfully under play therapy at 3 years 5 months 9. Where all documents were available for analysis, the adherence to local guidelines for sedation was 100% Conclusion 1. Sedation is a safe and effective option available in a DGH setting for young children needing relatively urgent radiological imaging to establish diagnosis where the benefits generally outweigh the risks. 2. Play therapy is a suitable alternative for cooperative children who can be adequately prepared. 3.Healthcare teams and parents need to be made more aware of these options in the future.

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MRI of the Achilles tendon-A comprehensive pictorial review. Part one (2021)

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Type of publication:
Journal article

Author(s):
Szaro P.; Nilsson-Helander K.; *Carmont M.

Citation:
European Journal of Radiology Open; Jan 2021; vol. 8

Abstract:
The normal Achilles tendon is composed of twisted subtendons separated by thin high signal septae, which are a potential pitfall on MRI because they mimic a tendon tear. Tendinopathy and full thickness tears may be assessed effectively both on MRI and ultrasound. MRI is superior to ultrasound in detection of partial tears and for postoperative assessment. The use of fat suppression sequences allows the ability to detect focal lesions. Sagittal and coronal sections are useful for assessing the distance between stumps of a ruptured tendon. Sequences with contrast are indicated in postoperative investigations and suspicion of infection, arthritis or tumor. MRI may reveal inflammatory changes with minor symptoms long before the clinical manifestations of seronegative spondyloarthropathy. The most common non-traumatic focal lesion of the Achilles tendon is Achilles tendon xanthoma, which is manifested by intermediate or slightly higher signal on T1- and T2-weighted images compared to that in the normal Achilles tendon. Other tumors of the Achilles tendon are very rare, whereas the involvement of the tendon from tumor in adjacent structures is more frequent. The novel MRI sequences may help to detect disorders of the Achilles tendon more specifically before clinical manifestation. Regeneration or remodeling of the Achilles tendon can be non-invasively detected and monitored in diffusion tensor imaging. Assessment of healing is possible using T2-mapping while evaluating the tendon vascularization in intravoxel incoherent motion MRI.

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Minimising negative ankle and foot X-rays in the Emergency Department-Are the Ottawa ankle rules good enough? (2014)

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Type of publication:
Journal article

Author(s):
*Crosswell S, *Leaman A, *Phung W

Citation:
Injury, 12 2014, vol./is. 45/12(2002-4), 0020-1383;1879-0267 (2014 Dec)

Abstract:
OBJECTIVES: To review fracture rates in patients who had X-rays of either the ankle or foot or both in the Emergency Department of a district hospital.METHOD: A retrospective review of 2589 Emergency Department patients who had X-rays of the ankle or foot or both over a 12-month period.RESULTS: There were 1199 ankle X-rays taken of which 193 (16%) showed a significant fracture. There were 1081 patients who had a foot X-rayed of which 165 (15%) showed a significant fracture. Younger patients had more X-rays but older patients were more likely to have a fracture. There were 309 patients who had an ipsilateral ankle and foot X-rayed at the same time, and of these 42 (14%) showed one fracture and just two (0.6%) showed a significant fracture of both ankle and foot.CONCLUSIONS: The approach to X-raying ankle and feet in this study is probably widespread, and Ottawa Ankle Rules still seem to be of limited use in diagnosing fractures. This low yield of positive X-ray could be accepted or a more sophisticated ankle rule introduced. Copyright 2014 Elsevier Ltd. All rights reserved.

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